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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Starting dialysis, whether early or late, is associated with reduced quality of life and poor prognosis in patients undergoing hemodialysis. However, the optimal timing for dialysis initiation remains controversial and inconsistent, largely due to the absence of reliable methods to evaluate variations in initiation timing. To address this, we developed a novel Dialysis Initiation based on Fuzzy-mathematics Equation (DIFE), which integrates nine biochemical markers and clinical variables that collectively influence the decision to initiate dialysis. To externally validate the clinical accuracy of DIFE, we designed the Assessment of DIFE (ADIFE) study.
In this prospective, multicenter, open-label, randomized, controlled trial, we enrolled 388 participants with stage V chronic kidney disease from 25 centers across mainland China. Using a Randomization and Trial Supply Management system, participants were randomized in a 1:1 ratio to the optimal start dialysis group, with a DIFE value between 30 and 35, or the late-start dialysis group, with a DIFE value less than 30. The primary outcome was all-cause mortality. Secondary outcomes included the incidence of major adverse cardiovascular events (MACE), the composite cardiovascular endpoint (MACE+), infections, and all-cause hospitalization.
Between April 2018 and May 2024, a total of 388 adults (median age, 56 years; 232 men and 156 women; 40.46% elderly patients; 136 with diabetes), underwent randomization, with a median time to the initiation of dialysis of 4 days (95% confidence interval [CI], 2 to 9) in the optimal start dialysis group as compared with 36 days (95% CI, 9 to 147) in the late start dialysis group (hazard ratio [HR], 2.89; 95% CI, 2.31 to 3.62); P<0.001). A total of 72.57% of the participants in the late-start dialysis group initiated dialysis when the DIFE values was above the 30, owing to the development of symptoms.
During a median follow-up period of 2.78 years, all-cause mortality occurred in 21 of 195 participants (10.77%) in the optimal start dialysis group and 22 of 193 (11.40%) in late-start dialysis group, no significant difference in rate of all-cause mortality was observed between the two groups (HR, 0.75; 95% CI, 0.40 to 1.41; P=0.38). Consistent with this finding, sensitivity analyses conducted in the Per-Protocol Set (PPS) and across prespecified subgroups also showed no significant difference in rate of all-cause mortality between the two groups.
The incidence of MACE+ was significantly lower in the optimal-start dialysis group than in the late-start dialysis group (HR, 0.51; 95% CI, 0.30 to 0.87; P=0.01), with heart failure being the most predominant contributing cause (P=0.001). No significant differences were observed between the two groups in the incidence of infections, all-cause hospitalization.
Dialysis initiation timing guided by the DIFE equation showed no significant association with all-cause mortality, MACE, infection, or all-cause hospitalization in patients with ESKD. However, the optimal-start dialysis was associated with a reduced incidence of MACE+.
